Unlock Hidden Revenue: Transparency in Coverage Secrets Revealed

Course Description:

This session will communicate the details of the Transparency in Coverage regulations that were passed requiring insurance companies to post contract rates they have with all NPIs by payor and by plan. The presentation will communicate how this data is provided by the payors, the benefits of obtaining the data and how it can be used by consultants, providers and their medical businesses to understand their opportunities for improving their standing with insurance companies and improving their reimbursement. Attendees will experience a walk-through of the Transparency in Coverage (TiC) rule along with the latest in CMS directives such as hospital MRFs and enforcement actions. Attendees will receive a checklist to support compliance success.

Learning Objectives:

Understand the Transparency in Coverage Regulations
Know what data is provided
Learn how the data can be utilized
What benefits can be derived from utilizing this data
Understand how rates within Transparency in Coverage data can be used to prepare for negotiations
Determine if you should take on an “offensive” or “defensive” approach to pricing transparency data
Hear updates on the patient estimation tool requirement and upcoming rules and legislation

Areas Covered in the Session:

Overview of Transparency in Coverage (TiC) Final Rule
- Machine-readable File (MRF) Requirements
- Internet-based Price Comparison Tool Requirements
TiC Requirements
TiC Implementation Timeline
Who must comply?
Machine-Readable Files (MRF)
Machine-Readable Files (MRF) Requirements
In-network Rate MRF
Data Elements Specific to Each MRF
Internet-based Price Comparison Tool
Internet-based Price Comparison Tool Requirements
Live Q&A Session

Suggested Attendees:

Healthcare CEOs
Healthcare CFOs
Healthcare COOs
Office Managers
Administrators
Billing Staff and Companies
Physicians and Other Providers
Healthcare Consultants
Compliance Officers
Physicians
Nurses
Practice Manager
All Practices
Medical Providers
Medical Billers
Claims Coders
In and Out of Network Providers
Hospitals and Facilities
Insurance Companies
Healthcare Attorneys
Hospitals and Facilities

About the Presenter:

David J. Zetter, PHR, SHRM‐CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP, is the founder and President of Zetter HealthCare, LLC in Mechanicsburg, PA and has over 30 years of operational and healthcare experience. David is nationally recognized for his presentations and expertise. He is well-versed in regulatory requirements, revenue cycle management, credentialing and contracting, compliance, coding and documentation. He is considered an expert on Medicare, not only by his clients but his consultant colleagues across the country. He has evaluated existing ambulatory care facilities and practices with respect to patient flow, operations, marketing, fee structures, use of ancillary services and financial considerations; developing strategic plans to improve profitability and productivity. His activities in management and compliance include physician practices, IDTFs, hospitals, ASCs, pharmacy, DME and other facility types, including coding and broad‐based regulatory issues. David has also conducted chart audits on behalf of Medicare contractors and Blue Cross/ Blue Shield early in his career, so he has knowledge of what the expectations are from the payers. David’s firm works with healthcare professional clients and facilities coast to coast, in all areas of practice and facility management including start‐ups, buy‐ins, compensation, exit strategies, reimbursement enhancement, practice financial modeling, governance documentation, policy and procedure development and implementation, credentialing and contracting, human resources staffing and management, compliance, coding and chart reviews, physician education and many other areas. David has helped to maximize both profitability and reimbursement of physician practices, facility and ambulatory practices, re‐engineered operational and human resources, and addressed coding and billing issues for providers to curtail fraud, abuse, kickback, OIG, and IRS issues. He is also an original member of CMS’ PECOS Power User Group, CMS Compliance Focus Group and MIPS Design Lean Work Group which provides feedback and recommendations to Medicare’s Center for Program Integrity and Provider Enrollment Operations Group on design and improvements to the PECOS enrollment environment, as well as, NPPES and MIPS and conducts beta testing of the EHR/ HITECH user interfaces and environments at the request of the Office of e‐Health Standards & Services Director. David is also on the CMS contracted team awarded the PECOS 2.0 contract to rebuild PECOS from the ground up. David has conducted practice management, human resource, coding and compliance education and seminars in many states over the past twenty‐five years. David speaks often on a variety of practice management subjects at hospital residency programs, the National Society for Certified Healthcare Business Consultants, the Medical Management Group Association, the American Academy of Professional Coders, AHIMA, Florida Institute of Certified Public Accountants, Florida Medical Society, many other venues and is often called upon by the MGMA, HFMA, DecisionHealth, Part B News, Part B Insider, and many others, to conduct audio conferences and webinars. He has been published in Medical Economics and interviewed and quoted in many publications including Report on Patient Privacy and Report on Medicare Compliance.

Additional Information:

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly

Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

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